About five in a hundred people have some degree of social phobia, with women two or three times more likely to be affected.

There are several ways of helping people with social phobia. These may be used on their own or together, depending on what you need.

Self-help

• If you are naturally shy, you may find it helpful to join a local self-confidence or assertiveness course.
• Learn some relaxation techniques – you can do this from books, tapes, CDs or DVDs. When you do find yourself getting anxious, you may be able to ‘nip it in the bud’ by using one of these techniques.
• Write down the automatic thoughts you have about yourself and the pictures of yourself these conjure up in your mind. Once you have done this, it can be easier to start changing them.
• Try listening more to what other people are saying, rather than what you are saying to yourself in your mind.
• Start to stop using your ‘safety behaviours’, beginning with the easiest.
• Break down a worrying situation into a number of steps, right from the beginning. Then take the first step and learn to feel relaxed while doing it – it may take some practice. Then move on to the next step, and then the next.

It will be easier to do these things with one of the many self-help books that deal with social phobia – see the reading list at the end of this leaflet.

Psychological treatments

Social skills training

This can help you to feel more relaxed and confident in company.

It does this by teaching some of the simple social skills that we tend to take for granted – like how to start a conversation with a stranger.  You can practice with other people and do what is called ‘feedback’ – people watch themselves practising on video to get an idea of what they are doing and how they appear to other people.

Graded self-exposure

We know that, even if you are very frightened in a particular situation, your anxiety will start to go away after a while. This approach helps you to do this for yourself, one step at a time.

You make a list of all the situations that you find frightening, and then put them in order, from the least frightening to the most frightening.

You start with the least frightening situation and, with the support of your therapist, keep yourself there until you stop feeling anxious.

You then move on to the next one and so tackle these frightening situations one by one. It is done in stages, each time making the situation a little more intense and frightening.

Cognitive Behavioural Therapy (CBT)

Social phobia is tied up very closely with the thoughts that you have about yourself, the world and the people around you – we can make ourselves anxious by the way that we think about things.

This treatment helps you to change the way that you think about yourself and other people.

The therapist will help you to be aware of:

• any unhelpful rules, assumptions or predictions (see above) that you regularly use – and the physical sensations you get when they go through your mind;
• any safety behaviours (see above);
• the unhelpful impact on your behaviour of thinking about these things all the time  – and the connections between these and your anxiety.

For example, take the situation when a conversation dries up. If you have a social phobia, you will tend to think it is your fault – you may have the automatic belief that “I never have anything to say” – and so you will start to feel anxious.

In CBT, the therapist will try to help you to be aware that it is just as likely that the other person has run out of things to say.

This is a more realistic and less worrying way of thinking about the situation. The therapist will help you to test these ideas out in your day to day life.

You can then start to focus on how other people are actually reacting to you, rather than your imaginary version of how they are. For instance, the therapist could ask you to talk while thinking to yourself that you have to appear very intelligent and amusing.

After a few minutes you would stop and try again, this time concentrating on how the therapist is reacting to you rather than what you are thinking.

Other techniques focus on the conversation, or ‘task in hand’ rather than any physical symptoms of anxiety you may be aware of. This sort of treatment is usually given by one therapist for each client. If the problem is very severe, or if you are unable to get out of the house, it can be given as an in-patient or as a day patient in hospital. 

Medication

Antidepressants

Medication should be used if a psychological approach has failed, if you do not want to try a psychological approach, or if you are very depressed.

The newer antidepressants (SSRIs – Selective Serotonin Re-uptake Inhibitors) have been found to be helpful in social phobia, but may sometimes cause headaches and dizziness in the first few weeks.  They usually start to work within 6 weeks, but can take up to 12 weeks to have their full effect.

If the symptoms of social phobia get better, the dose can be slowly reduced over several months.  About half of those who start taking antidepressants will get worse again when they stop taking them.

If SSRIs do not help, Monoamine Oxidase Inhibitors (MAOIs) can be tried. These have drawbacks.

They tend to lower the blood pressure which can make you feel faint. Some foods, such as cheese and yeast extract, can produce dangerous reactions with these drugs, so you have to follow a special diet which leaves out these foods.

Some cough medicines that can be bought at the chemist also produce similar reactions to these foods. There are now some new MAOI drugs called RIMAs (Reversible Inhibitors of Monoamine Oxidase – A). These don’t seem to produce the above reactions, and so people taking them can eat what they like. Other types of antidepressants don’t seem to work very well in social phobia.

Beta-blockers

These drugs are usually used to treat high blood pressure.  In a low dose, they control the physical shaking of anxiety – which can be a symptom of social phobia – and can be taken shortly before meeting people or before speaking in public.

Tranquillisers

Drugs like Valium were used in the past to treat all sorts of anxiety. We now know that they are addictive and that they do not help in the long run. They should usually not be used to treat a social phobia.

How effective are treatments?

• Pure self-help, using books without a therapist, seems to help some people a bit, but it doesn’t reduce the impact of the social phobia on  their life. This may be a good choice if your anxiety about social situations is troublesome, but doesn’t stop you from doing too many things
• Self-help with group meetings seems to work better, but is relatively new.
• Graded self-exposure seems to work for about half the people who finish the course – but quite a few people don’t complete it.
• CBT seems to be better than SSRI medication and should be provided before medication is tried.